Provider Demographics
NPI:1700991783
Name:NATHAN, TAMRA C (PT)
Entity Type:Individual
Prefix:MS
First Name:TAMRA
Middle Name:C
Last Name:NATHAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:TAMRA
Other - Middle Name:C
Other - Last Name:EATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 QUEBEC ST BLDG 600
Mailing Address - Street 2:SUITE 215
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7144
Mailing Address - Country:US
Mailing Address - Phone:303-341-0369
Mailing Address - Fax:303-341-0866
Practice Address - Street 1:200 QUEBEC ST BLDG 600
Practice Address - Street 2:SUITE 215
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7144
Practice Address - Country:US
Practice Address - Phone:303-341-0369
Practice Address - Fax:303-341-0866
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70013088225100000X
CO10663225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA100214Medicare PIN